Month: April 2020

This is the third article on almost identical subject. First was published on April 2nd. It summarized uneasy feeling: are we doing right by our seniors? Especially the ones totally helpless, confined to places called Long Term Care Centres. How, as a society, we do really care about them? Does what we preach reveals itself in what we do? And if it doesn’t – if our values have no meaning other than making us feel good about ourselves?

On the 16 of April, I published the second article. We were just beginning to understand the horrific scale of the tragedy that was going on behind the closed doors of many Long Term Care institutions. The ‘care’ was fully missing from them, the ‘long term’ was being shorten in a dramatic fashion.

In some provinces the percentage of all Covid-related deaths was in sixties, seventies and even higher percentage among the Long Term residents versus the entire provincial populations of Covid deaths. People were even dying not being infected but simply from lack of basic health. From abandonment.

There is a)moral culpability; b) political guilt and blame; and c) criminal negligence.

First (culpability) is the most important, although not punishable by law. In criminal cases the term ‘culpability’ is not the same as ‘guilt’. But we are not taking about law. We are talking about morals, ethics. An entire society (state) cannot punish itself. We can’t be a judge, a prosecutor, an accused, a defender and a jailer at the same time. But it is the most important one. It does give credence to political and legal actions. Moreover – it creates a path to action of all societal and state institutions.

Therefore without a tacit (at the very least) nod from us, from society – the state would not allowed things to disintegrate as much as they did. The state itself is void of morals. It professes them very often in its highest form, like Constitutions or Charts. To a lesser degree in criminal and civil codes. But the state is not run by this high documents (except in very rare cases and most of the time it would be because of citizens appeal to a Court for remedy against actions the state) – a government and state is run every day by regular acts of parliaments, by decrees of government and (most often) by internal regulations of different ministries and state agencies. In that, the Government and Administration takes a clue from political measurement of the will or sympathies of electorate. Here comes point ‘b’: political guilt and blame. What the government does in gauging the sympathies of electorate is a risky business. But you can’t govern without taking the risk. Generally speaking the government gets ‘away with a crime’ (in a manner of speaking) most of the time. It is a game played in every state, democratic and authoritarian alike. In a democracy the government is more timid and careful with it. By judging the society feelings mistakenly – it would be judged severely by next election, which is never very far. In dictatorships, the government can get away with a lot more – the only risk is a revolution, usually bloody and very dangerous, therefore very seldom taken up by society.

But the ‘guilt’ and ‘blame’ is something that every politician tries to avoid as much as possible. Careers and prospect of losing power is very real.

Last one is ‘c’ – criminal negligence. It happens very seldom in case of Government actions. But it can, by individual minister or high ranking administrator. In this case the price is political and criminal case, almost always supported by the State itself. This way the State (government) acts not as perpetrator but as a defender of morality of society and defender of the High Acts (Constitution, special Charts that are treated the same as the Constitution). But most of the time criminal negligence is a result of either private, individual citizens or private businesses, agencies. In both cases the peace of the state, the agreement between Society and the State is maintained. We, as a society, have manifested to the Government that such actions are not tolerated by us and the State instituted legislation and rules that prevent others from breaking such rules. Under the duress of punishment, of course. Therefore we all can attest that there is ‘nothing rotten in the state of Denmark’. Or can we?

I think that all points (a, b and c) rise up to crimes (moral, political and criminal). Yes, it is true that we profess the dignity and care to all citizens; more than that – to all that reside even in a short period within our borders. We profess that the care of vulnerable and weak one among us deserve special care and help from the State. The tacit understanding is that the most important among them are the very young and the very old.

Then comes a test. Like a school exam. That test came to us in a form of pandemic of new, unknown and dangerous virus – coronavirus and an illness called Covid-19.

And we all failed miserably. But especially provincial governments. Of all and different political stripes: conservative, liberal and NDP alike. I am not trying to absolve the federal government from all and any responsibility. But the simple truth is that these facilities and entire management of health system lies strictly at provincial doorsteps. With no exception. And it is guarded by them very jealously from interference of federal power. After all, it costs enormous amounts of money that they must receive from federal coffers. And money is power in politics. Well, such is our constitutional devolution of power.

But, specifically about long term care for seniors, our subject. They too, like hospitals, fall under provincial jurisdiction, regulations and control. The institution itself is rather old. After the 2 world war they become regular part of our society. People lived much longer, not only men but also women become regular part of workforce, therefore their time at home was very limited. More and more people moved to larger cities and old communal forms of help and looking after each other changed and become harder to come by. But the last 25 years skyrocketed in opening more and more of this institutions. Mainly because of the almost pandemic in itself spread of different types of dementia, with its most dangerous form: the deadly and untreatable Alzheimer disease. We all become very familiar with them, if not our own mother or father, than someone we know ends up in these long term centres. Something that a lot of us is not aware of, is the fact that there is growing number of residents there, who are much, much younger than typical seniors. Some in their late 30. or 40ies even.

Such a large number of this centres become a financial burden on provinces. As very intensive and specialized medical care is not really part of their operations, the governments decided to let them be owned and run by private businesses. Of course, most of funds for the centres do come still from the provinces as the monthly rate usually is much higher than ordinary senior can afford. In most cases they do offer much safer and better setting for our seniors than would be possible, even under very good conditions, at home. Looked like we all stuck a good deal. Provinces still safe money than running their own care centres and we (society) had our parents and grandparents in safe place. Of course, over the course of many years we all have heard awful stories of bad care, lack of services, appalling conditions in some of them. That was not the norm, though. Not uncommon, but not something we expected as a norm. If we complained loudly and persistently enough – things get better. Maybe not for all, but at least for our close one.

My Mom spent last years of Her life in such a Centre. Can’t even imagine Her and mine horror if she would be in one right now. I dedicate this article to Her memory.

But we always believed that there is (perhaps not very rigorously applied) a strong provincial oversight.

Especially if something bad was going to happened. Like, let say, pandemic or epidemic for example. How could there be not? Yes, there were signs. Remember, very recently, Baptist college educated nurse Elizabeth Wettlaufer, who murdered eight and seriously injured six (that we know of) senior residents in the long term centres she was employed by? Her murders went on for years. Yet, nor serious investigation was ever (until the last one when police was called in) conducted. If not for her ‘bad luck’, maybe she would have been working still and continuing her murderous calling?

But back to Covid. At least very early in February everybody federally and provincially knew, that the new strange coronavirus seem to be particularly deadly among old people. Everybody working in the field of medicine and care. And administration of such. What type of plans were prepared and issued to the care centres? How many detailed and practical seminars were given to administration and employees of these centres? How many special provincial watchdogs were given orders to regularly oversee each and every one of such centres? Check documents, staffing level and preparedness of staff? Offer them the same, or similar, PPE for use? Made sure that regular testing for virus by mobile units were available more or less day and night if needed? Required a full and immediate death certificate on any death in facility to be examined if it could have been due to a coronavirus? Made preparations for supplementing and augmenting existing care workers in such facilities in case of shortages ? Any? Seriously? O, yes. We locked them. This way no one could have seen … .

Let me make a confession. Being, as millions of others nowadays, at home I watch a lot of TV. Mostly news, as I always was a news addict. Political junkie almost. So I watch, day after day, week after week daily conferences of Prime Minister and Premiers of all provinces (Yukon and Nunavut – thanks Almighty! – do not hold them on national news). And listen to them. And listen. We are not doing, as far as the illnesses and deaths are concerned, too bad in Canada with the pandemic. Not so good economically, psychologically but not very bad in strictly medical terms. The governments seem to be doing actually a good job. Starting with the right approach by Prime Minister and by far by most premiers, also. Generally speaking. We, Canadians. Unless we are not weaker, often confused, oldest generation locked in the Care Centres. If we are – we are doing absolutely awful. Tragically awful.

So when I listen to the conferences, every day I’m waiting for the premiers, any premier, to actually admit and say honestly: ‘we have failed our seniors and I, as a Premier of my province, am very sorry for failing to do the job that I was entrusted to do. And I promise you all that as soon as the pandemic will end or would become manageable, I will order a full review of all regulations and laws governing Long Term Care Centres for Senior and undertake serious overhaul of the current system. Because the system has failed you’. So far – none was issued. Instead, I listen as the premier admonishes me to stay at home, maintain social distancing and to remember that I have to protect not even myself but the most vulnerable in our society: the sick and old ones. And I do. But you didn’t, Mr. Premier.

Yesterday was a very moving and touching Moment of Remembrance from Nova Scotia and from Canada for Nova Scotia. From us to the families and friends of 22 victims of terrible gun massacre last weekend.

From dignitaries, ordinary people, artists, religious leaders. And it was organized not by governments but by grassroots group of private citizens. We all had a time to held the memory of the Victims in our thoughts. Needed time. And helpful for their close ones, who must go through unspeakable terror of coming to terms with what just happened.

Because of the pandemic and very strong restriction on any movement of people and cars through the province and indeed entire country, world – many of us, who would have gone to their places , churches and halls to give them a hug, a good word and promise that they are not alone in their grief – did it that way. In front of our TV, radios.

I wen today to the place were the facts of the shooting is being gathered, analyzed. Place were people already made a quick memorial to fallen RCMP officer and by natural extension – to all the victims. Therefore, in a symbolic way, a Memorial to all victims, a place we can say goodbye to them and we can say ‘Im sorry’ to all the grieving families. To ourselves as a grieving community. Silence, respectful, individual visitors. A teddy bear, two red hats, plenty of flowers, signs, candles…

The pictures will give you a glimpse of it, hopefully the silent atmosphere of sadness and sorrow. The Provincial Headquarters of RCMP in Nova Scotia.

Right by the RCMP massive building is a small enclave of natural marches and little Spectacular Lake in the middle. I walked through the empty trail, surrounded by the eerie colours of the marshland, the green tops and branches of trees, the quite water of the pond. All in silence. It felt like a walking in a funeral march… Yet, tiny new buds on bushes, few birds surprised by my presence, a microscopic brook between trees – were alive. Or were waking up. So will we. And so will, in time, the Families of Victims. Life will go on. But we will remember.

In my last article I have shared my reflections on the situation of seniors in our society during the coronavirus pandemic. How we, as a society, have to or ought to revise our responses to it; re-examine our ethical compass. More or less, I have challenged us to check if our own beliefs in our own societal, (but also individual) set of ethical and moral values holds the water. Or is it just a lofty goal fare removed from reality. The weakest are often the first ones we shamefully discard from our Decalogue of ‘do’s and don’ts’.

That was at the beginning of the epidemic and just on the edges of a serious crisis, when we heard of the tragedy in North Vancouver’s senior care home. And the full closure of all of them resulting in a practical lockdown.

But that was than. What followed in ensuing weeks, is just a full scale tragedy and collapse of the system. As Doctor Theresa Tam, our Chief Medical Officer, noted – almost half of our reported deaths were linked to care facilities or seniors homes.

In Quebec and Ontario we have learned of appalling, almost concentration camp-like lack of care and, practically speaking, an abandonment of the seniors by the operators of these centres.

There is no reason to hope that in other provinces the situation is very different and drastically better. To the contrary. Just today we learned of many cases and deaths in Nova Scotia seniors care centres. There is very strong argument to expect the same everywhere in these type of centres. If not worse. Why? Because it didn’t happened in a vacuum. It happened on our collective watch. Under the eyes of provincial regulators and government. As we found out, but should have known much earlier, these controls and ‘eyes’ of public health were most of the time closed. Or wilfully blind by design. Don’t see – don’t know. Therefore: if I don’t know, I can’t do anything about it nor to feel guilty or at fault.

But they should feel guilty. They are at fault. We all are. 40 years ago seniors full care centres were little known and not very numerous. But with the advance of modern medicine, extended life spans of all of us, that changed. Some of us (before we die) in an advanced old age loose gradually a lot of physical abilities to be independent or to require only basic care and help from family and friends. Some loose gradually mental capacity to take care of ourselves. That is even more dangerous. Advanced age means also that all of our children (if we have any) are not young either, by the time we become very old and in need of help. Majority of advanced age seniors children are … seniors themselves.

And let us not forget the various types of dementia, with Alzheimer being the most dangerous of them, that seem to spread like a wild fire in recent decades. These conditions and ailments require a specialized, non-stop medical and household care. The word ‘medical’ is paramount. Dementia and Alzheimer are medical ailments that require medical treatment. Not just the mundane cooking and laundry and help with personal hygiene. A progressive disease with no cure. Lethal. But the length of it often is very long – from mild form to almost vegetative state in some cases. Ugly. Robing the person of almost every shred of personal dignity. Shall I go on? No. A lot of you knows it, because someone close to you is going through it or went through it before dying, when one by one, every organ of your body stops working. Not like in a heart attack. That would be considered almost merciful. A majority of you, who never encounter it in a family setting – will know it.

Why am I writing about it in painful detail almost? To make you understand, that if not majority, a very sizable number of full care Centres they are there because they have no other choices. Not because it is just more convenient for them. You know – the food that someone else shops for and cooks, the plates and dishes that someone else cleans after you, the laundry, the cleaning of your room, changing of bedding, doing your hair, your nails, your showers and baths (at the end it is just wet sponge and wipes ), the moving you from bed to wheelchair and back. The list goes on. It is medically necessary. Like a hospital is not a hotel we choose to go to for fun. Like a hospital. That is another term I want you to remember.

So we have two terms now to pay attention to: 1) the reason for senior being in a centre like that is of medical nature, not simply an age or convenience;

2) the care, nurse and doctors check offs, adjusting and giving out medicine (pills, shots and the likes), medical treatment in general. At the end it also serves as a palliative care institution.

Again – as in hospitals. The difference is that hospital is an active medical trauma treatment centre, with vast array of diagnostic tools, and possibility of very decisive medical intervention. By nature designed for relatively short stay. Full care senior’s centres are designed to be a residence. Usually extending beyond one year, or close to it. Regular hospitals would be absolutely way too expensive to operate under such conditions. Hospitals offer acute treatment, with a goal of a cure for patient. Seniors homes offer light medical treatment (with no practical nor even idealistic goal for curing residents), safer environment and at the end of resident’s stay – palliative care. Unless when there is an unexpected accident that require hospital intervention or specific family’s requests for transfer to a hospital for more active intervention.

But let’s not make any wrong distinctions: both are of medical nature. One short term and expectation of curing patient (hospital); the other very long term stay (by nature – final) and no expectation of curing patient – just making her/him safer and relatively comfortable. Neither is an extension of home. They try to be as much as possible – but they are not. Governments spent huge amount of money to subsidize most residents stays there. Some can afford to pay it themselves, but it would be a minority as the costs are in thousands of dollars every month. All provinces decided many years ago that it is more economical to let the centres be in private hands, run as businesses, then in governments hands. And we let them. Yes, it would have been more expensive to run them by government. Just the labour cost by itself – in hospitals professionally trained staff is paid much higher rate, than similar staff in the centres. Of course other costs, too. For example continuing training and education of hospital staff versus very limited training of similar staff in the privately run centres. Hospitals are not run on a business model. And they shouldn’t be. The Centres – are. The operators/owners are running a business, not a charity.

The results, in an emergency situation of even lesser magnitude than the pandemic, are the way they are. Tragic. Shameful. Incomprehensible. Existing model is wrong and is not working under stress. Barely under normal circumstances. We are left powerless, not even knowing what is happening to our parents, aunts, family members and friends, who are locked behind these walls.

This can not be put squarely at the operators feet. It is a fault by design and if not equal, at least a partial blame is on the side of the government. The regime set-up to control and supervise the centres by province’s Health Authorities failed. Again – be design. By not making it robust and strong enough. By not following own rules, which by themselves are minimalist and weak.

If the provinces can’t guarantee a fast and permanent fixing of the oversight – it should take over the running of the establishments under its own umbrella and ownership. It is an extension of medical care.

If the model of having them in private hands is honestly believed as a more efficient one and better – than an extensive overhaul of the Health Authorities effective control and oversight needs to be undertaken almost immediately. With the public being clearly informed of the process, it’s goal and timetable for conclusion. Proper staff-resident ratio must be established by the province and remuneration for employees should mirror the importance and the professionalism that is expected of them. You can’t expect the staff to be paid near minimum wage and do properly the extremely hard work they do. Extremely hard and difficult – of that I know, for I have spent hundreds of hours in such facility. During daytime, at night, mornings, evenings. On purpose, as I wanted to make sure that ‘good’ things are not happening only during typical visiting hours. Helped them wash residents, change them, feed them. I can’t say: I wouldn’t do it for any money. No, I have done it for free. But if I was to work there, I wouldn’t under any circumstance be paid less than minimum twice as much as they were paid. None of the blame could be placed under their feet. Of that I’m certain.

The pictures in my mind of the neglected and left to their own inability to do almost anything residents in some of the Homes in Ontario and Quebec (I am also certain that they are like that in every other province) are seared in my brain and heart. Most of you probably listened or read the recent stories. I will not repeat the details here. Sufficient to say, they are horrific, inhuman pictures.

Something must be done and we (that means you too, dear Reader) must make sure that it will. Call, write to you MP, to your premier, minister of health, minister of social services, senior’s advocate. Please, do. Our mothers, fathers, aunts, uncles, cousins, grandparents, our friends – deserve better. You deserve better in the future, when you might (which is becoming increasingly common) become a resident in one of them.

In North Vancouver, in Lynn Valley Seniors Care facility we heard it first. First sample of what was going to come. Covid-19 infections among staff and residents. Later came other Homes like that. In Ontario, Nova Scotia, New Brunswick, Quebec. Vancouver was first, before the epidemic spread all over Canada. We were still innocent, still reading about far away places. Life was to a large extend normal. Comparing to today—life was as nothing was happening. We were still innocent … .

People at the end of their long life. People, who’s life expectancy, at best, was maybe three years, maybe five. If they were lucky maybe 7 or 8. A lot of them wouldn’t last even the three years.

We all are going to die, if we are lucky at an old, ripe age. But for some of us, increasingly more, as society evolves, that wont be the worse. Some of us will not only be old and weaker. We are going to be in a state of health, mental and physical, that will rob us of independence. We will become dependent on others, not only in tasks but also in decision making. And it will rob us off a large portion of our dignity. And it is a lie, that those of us who will have dementia, advanced Alzheimer, will not feel it, recognize it. They will. And they are. In different way, but they are. They know that they are constantly being told what and how to do, being washed, dress, undressed, whether they want to or not. They are being moved to places and spots they don’t want to be moved at that moment. I know that. My Mom was one of them. I spent most of my free time with her at a Home like that for almost five years. That’s a long time. She wasn’t abandon or ‘dump’ in there. I couldn’t provide her the absolute care and safety, she needed. Even if I was a very rich person, it would require a non stop 24 hours care, special facilities. She wasn’t a nuisance in my life, nor inconvenience. To the contrary—she enriched our life every day. There was just no other option. And it was a right decision. She felt almost right away safer and comfortable . I could see it in her eyes. The fear disappeared. The fear that that she needs to go and do something and wont be able to find her way back. That there were people around her all the time. And there was no demands on her to do anything, to remember anything. Somehow she sensed it and it must have been a relief. She didn’t have to pretend anymore that she is OK. She knew she wasn’t. And that was OK. Of course, her situation was very different from many other residents—we still were spending many, many hours together. I was almost a resident there, myself. We used to go still for long walks, long drives, to familiar parks. Sometimes, as in older times, we wouldn’t come back until very late, as she used to laugh about it: ‘in indecent hours’. A lot of dinners, suppers were still at my place were she felt comfortable. She even slept sometime in our home. But she didn’t like it too much. She preferred to go to ‘her place’, back to the new Home, were she always had a separate room and everything become very familiar. Home. It become her home. And, after years in this new home, her time has come to say goodbye. I was with her the last few days and nights constantly. Touching her, talking to her. I don’t know for sure whether that made a difference for her in the last hours. I would like to think it did. She seem to be relaxed while I touched her, she tried to squeeze my hand, open her blue eyes. I didn’t see any panic in her, paralyzing fear. But that is what I think. She wasn’t able to communicate with me anymore. What I know is that it was extremely important to me. That I couldn’t leave her in that moment, that she shouldn’t be alone.

That was in a different world. That was a time before the pandemic. What would I have done today? I don’t know. It is a horror. Horror to try to think about it. A time when we, as a society, allow ourselves to make such a terrifying decisions. And we find for it every possible rationale, every lofty ideas. But it doesn’t make it right. We know it doesn’t. Yet, our safety mechanism tries to protect our sanity and our sense of morality by invoking such explanations, such excuses. Few for the benefit of entire group; individual for the good of society. This heroic choices we read about in books, in myths, in legends. Sacrifice. The word does have a powerful, uplifting, albeit tragic, feeling. Except … except when someone else makes that decision for us. When the sacrifice is given as an order, as a decision taken not by the individual, but by some mysterious collective. Society. As in the case of this pandemic.

I listened the other day to a doctor, who was commenting standing in front of one of these Senior Care facilities, where the virus spread. She was sad, and probably uneasy about it. And simply stated: “I hope they will not all die’. That was all she could offer: I hope they will not all die. The way she said it, the entire situation and a way we comment about it, report it, struck me. It sounded like we are all standing in front of burning library, we are all resigned that there is nothing we can do but just let it burn. And with a natural sadness we take a sigh and say: we hope that not all of the books will burn.

Yesterday it would have been, I think, possible to expect that someone, one of us, maybe even entire group of bystanders, would rush to the inferno trying to safe the books. Risking their own life. And that would have been seen as a nobler action. Not common perhaps, but noble nonetheless. These thoughts, this ideas about society and individual are becoming the silent victims of the new world in pandemic. They are very disturbing victims. It will take a while to assess the impact of such actions, such permissions. I would rather not have been a witness to these choices, these re-evaluations of human condition and humanity.

There were crazy times in Western (not only) Civilization, when the common motto was a Latin saying ’memento mori’. Remember about death. Remember that you will die. Sort of apotheosis of death. More important and more powerful than life, which had no other meaning but to lead us to that threshold. Recent centuries led us to abandoning this concept. To the opposite. Remember that you are living. Life is the most precious thing. The new omnipresent god. Are we starting to burn on the altar of this new god new sacrifices? Have we given it a deep thought and ethical exam?

These are the disturbing thoughts that have given me first sleepless nights since the pandemic begun. The lonely, tragic deaths in facilities that are being call “Seniors Care’. Care. Is it always in the new world? Or the meaning of ‘care’ become ambivalent, not set in stone, changing? How far are going to change these notions? At what cost to the society? What is decency? Sacrifice?

I don’t know the answers. But it makes me very uncomfortably, when the answers are provided ad hoc, as an edict, by some Administration Body, some centre of local administrative power. No matter how good the intentions are. Because I am not sure that the Administration knows the meaning of the word “good”. It is much more than ‘good car’ or ‘good dinner’. The word has immense value, is a cornerstone of our foundation.